Consensus Report on Patient Blood Management in Cardiac Surgery by Turkish Society of Cardiovascular Surgery (TSCVS), Turkish Society of Cardiology (TSC), and Society of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care (SCTAIC)

Abstract

Anemia, transfusion and bleeding independently increase the risk of complications and mortality in cardiac surgery. The main goals of patient blood management are to treat anemia, prevent bleeding, and optimize the use of blood products during the perioperative period. The benefit of this program has been confirmed in many studies and its utilization is strongly recommended by professional organizations. This consensus report has been prepared by the authors who are the task members appointed by the Turkish Society of Cardiovascular Surgery, Turkish Society of Cardiology (TSC), and Society of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care to raise the awareness of patient blood management. This report aims to summarize recommendations for all perioperative blood- conserving strategies in cardiac surgery.

Keywords: Cardiac surgery; bleeding.; patient blood management; transfusion.

Figure 1. Preoperative management of dual antiplatelet therapy according to thrombotic and bleeding risk in cardiac surgery. ASA: Acetylsalicylic acid.

Figure 2. Perioperative management of dual antiplatelet therapy in cardiac surgery. * After discontinuation of P2Y12 within 72 hours without bolus dose; Tirofiban: 0.1 µg/kg/min (If creatinine clearance <50 mL/min 0.05 ?g/kg/min); Eptifibatide: 2.0 µg/kg/min (If creatinine clearance <50 mL/min 1.0 ?g/kg/min); + After discontinuation of P2Y12 within 72 hours without bolus dose; 0.75 µg/kg/min (No need to dose adjustment in renal failure minimum 48 hours to maximum 7 days) ** If no oral intake ++ If no oral intake *** Within 24-48 hours when oral intake starts, clopidogrel should be given in 75 mg/day maintenance dose following 300-600 mg bolus dose. Prasugrel and ticagrelor are not recommended.

Figure 3. Perioperative management of oral anticoagulant therapy in cardiac surgery. Bridging algorithm for the patients using oral anticoagulation and undergoing cardiac surgery. VKA: Vitamin K antagonist; INR: International normalized ratio; UFH: Unfractionated heparin; LMWH: Low molecular weight heparin; DOAC: Direct oral anticoagulant; CrCI: Creatinine clearance.